Men's health Flashcards
What is erectile dysfunction (impotence)
the persistent inability to achieve or maintain an erection sufficient for sexual performance
Give 5 RFs for erectile dysfunction
- increasing age
- coronary and peripheral arterial disease
- excess alcohol and smoking
- metabolic syndrome: HTN, hyperlipidaemia, diabetes, obesity
- drugs: SSRIs and beta blockers
Give 3 factors favouring an organic cause of impotence
- Gradual onset of symptoms
- Lack of tumescence
- Normal libido
Give 4 factors favouring a psychogenic cause of impotence
- Sudden onset of symptoms
- Decreased libido
- Major life events
- History of premature ejaculation
How is impotence investigated
- fasting glucose and lipid profile to calculate Qrisk
- all men with ED should have their testosterone levels checked
- Free testosterone should be a morning sample (9-11am)
- If free testosterone is low or borderline, it should be repeated along with FSH, LH and prolactin levels
Name two questionnaires are used in the assessment of impotence
- international index of erectile dysfunction (15 Qs)
- sexual health inventory for men (5 Qs)
Non-pharmacological management of impotence
- treat underlying condition
- reduce weight, improve diet, increase exercise
- psychosexual therapy
- referral to urology if the patient is young
- Stopping cycling for a trial period, if a man regularly cycles for more than 3 hours a week
Pharmacological management of impotence
- phoshodiesterase-5 (PDE5) inhibitors - e.g sildenafil, ‘Viagra’, tadalafil or vardenafil
- vacuum erection device if PDE5 CI
- alprostadil penile intracavernous injections
Give 3 contraindications to PDE5 inhibitors
- Hypotension
- Unstable angina or angina occurring during sexual intercourse
- MI in the last 90 days
- stroke in last 6 months
Give 4 side effects of sildenafil
- visual - blue discolouration
- headache
- nasal congestion
- flushing
- priapism
When is the peak incidence of testicular cancer
age 20-34
What is the most common type of testicular cancer
Germ cell tumours
What are the two main types of germ-cell tumours in testicular cancer?
- seminomas
- non-seminomas
Name some types of non-seminoma germ-cell tumours.
Embryonal, yolk sac, teratoma, and choriocarcinoma.
Name 2 non-germ cell tumours associated with testicular cancer?
Leydig cell tumours and sarcomas.
What is the peak incidence age for teratomas in testicular cancer?
25 years.
What is the peak incidence age for seminomas in testicular cancer?
35
Name some risk factors for testicular cancer.
- Infertility
- cryptorchidism
- family history
- Klinefelter’s syndrome
- mumps orchitis.
symptoms of testicular cancer
- a painless testicular lump - mc
- occasionally presents with pain
- hydrocele
- gynaecomastia
Why does gynaecomastia occur in testicular cancer?
Due to an increased oestrogen:androgen ratio.
What are the tumour markers associated with testicular cancer
- seminomas: hCG may be elevated
- non-seminomas: raised AFP and/or beta-hCG
- LDH is elevated in around 40% of germ cell tumours
What is the first-line diagnostic test for testicular cancer?
Ultrasound
How is testicular cancer managed?
- Orchidectomy
- chemotherapy or radiotherapy depending on staging and tumour type.
What is the most common cause of scrotal swellings seen in primary care
Epididymal cysts
Features of epididymal cysts
- separate from the body of the testicle
- found posterior to the testicle
What is a hydrocele
accumulation of fluid within the tunica vaginalis
Features of a hydrocele
- soft, non-tender swelling on one side of the scrotum that transilluminates
- the swelling is confined to the scrotum, you can get ‘above’ the mass on examination
How are hydroceles managed
- infants: repaired if they do not resolve spontaneously by the age of 1-2 years
- adults: USS to exclude tumour, conservative
What is the typical cause of acute bacterial prostatitis?
Gram-negative bacteria (Escherichia coli) entering the prostate gland via the urethra
What are some risk factors for acute bacterial prostatitis?
- Recent UTI
- urogenital instrumentation
- intermittent bladder catheterisation
- prostate biopsy
Features of acute bacterial prostatitis?
- pain of prostatitis may be referred to a variety of areas including the perineum, penis, rectum or back
- obstructive voiding symptoms
- fever and rigors
What would a digital rectal examination reveal in a patient with acute bacterial prostatitis?
A tender, boggy prostate gland
Management of acute bacterial prostatitis
- 1st line: ciprofloxacin BD 14-day
- above CI: trimethoprim
- screening for STIs in a young male
Most common form of prostate cancer
adenocarcinoma
RFs of prostate cancer
- increasing age
- obesity
- Afro-Caribbean
- FHx
Features of prostate cancer
- bladder outlet obstruction: hesitancy, urinary retention
- haematuria
- pain: back, perineal or testicular
What would a digital rectal examination reveal in a patient with prostate cancer?
asymmetrical, hard, nodular enlargement with loss of median sulcus
Investigations of prostate cancer
- first line: multiparametric MRI - results reported using a 5-point Likert scale
- If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
management of Localised prostate cancer (T1/T2)
- conservative: active monitoring & watchful waiting
- radical prostatectomy
- radiotherapy: external beam and brachytherapy
management of Localised advanced prostate cancer (T3/T4)
- hormonal therapy
- radical prostatectomy
- radiotherapy: external beam and brachytherapy
common complication of radical prostatectomy
erectile dysfunction
Complications of radiotherapy for prostate cancer
- proctitis
- increased risk of bladder, colon, and rectal cancer
What are the common approaches to hormonal therapy for metastatic prostate cancer?
Anti-androgen therapy:
* synthetic GnRH agonists (goserelin) or antagonists (degarelix)
* bilateral orchidectomy
